brain From the brain and from the brain only, arise our pleasures, joys, laughter and jests, as well as our sorrows, pains, grief's and tears. ~Hippocrates Marilyn Rose

meninges 3 membranes Outer- Dura mater- folds house the following: flax cerebri- cerebral hemisphere tentorium cerebelli – cerebrum/ cerebellum falx cerebelli- cerebellar hemispheres Middle- arachnoid- separate from dura by subdural space. Inner- Pia mater- vascular, adhering to the brain- separated from arachnoid by subarachnoid space- which is where CSF circulates

Brain Bleeds- Hematoma Subarachnoid- Rupture AVM/ aneurysm Worst headache of life Between arachnoid and pia Epidural Traumatic (artery) Blood between dura and skull Subdural Traumatic (vein) Shearing/ shaken baby Blood between arachnoid and dura

Subarachnoid Epidural Subdural

tent, falx and cerebellum Falx cerebelli Tentorium cerebelli Tent Cerebellum= Posterior Fossa http://anatpat.unicamp.br/minDsc78051a+.jpg

ventricular system Circulation of CSF though CNS 4 cavities: RT/LT lateral vents- one in each cerebral hemisphere separated by cavum septum pellucidum (frontal, (atria) occipital, temporal horns) Choroid plexus- blood vessel network (bright) within lateral ventricles - producing CSF- BEGINS POSTERIOR TO 3rd vent 3rd opens downward-foramen of Monro- lateral= thalamus 4th opens from cerebral aqueduct- anterior to cerebellum and posterior to the pons- CSF goes though Magendie (Cisterna magna-spinal cord) and Luschka (subarachnoid space)

Head Ultrasound… 3rd vent- blood anterior Level of 3rd with blood Normal Choroid posterior to 3rd vent

http://www.i-am-pregnant.com/images/ventriculomegaly2.jpg http://bstr431.biostr.washington.edu/syl/lab2/fig204.gif http://en.academic.ru/pictures/enwiki/71/Gray735.png

axial Pre and post birth imaging of the brain Coronal Sagittal http://www.childrenshospital.org/clinicalservices/Site1867/Images/brain1b.jpg Sagittal http://www.justthefactsbaby.com/images/news/2nd-tri-25wkBrainweb.jpg axial http://www.health.com/health/static/hw/media/medical/hw/h9991198.jpg

Choroid Plexus Normal or abnormal??? Level of the 3rd ventricle http://www.i-am-pregnant.com/images/Choroid-Plexus-Cysts-(CPC).jpg Level of the 3rd ventricle

cerebrum cortex- gray/white matter Rt/Lt hemispheres Gyri- folds Sulci- groove- central sulcus frontal (motor) / parietal lobe (sensory) Fissures- deeper grooves- longitudnal- superior sagittal sinus/ flax (Rt/Lt) lateral- Sylvian- frontal/ parietal from temporal lobe. Corpus callosum- largest bundle of white matter w/ in cerebrum forms roof of the lateral vents connects Rt/ Lt cerebral hemispheres 4 parts= rostrum, genu, body, splenium

Corpus Callosum http://psycnet.apa.org/journals/neu/17/3/images/neu_17_3_496_fig1a.gif http://img.medscape.com/pi/emed/ckb/radiology/336139-407730-7910.jpg

Locate the corpus callosum… www.come-over.to/FAS/corpuscallosum3.jpg

What is wrong? http://neurosurgerydallas.com/images/2_1_3_5b.jpg

Label the arrows- 1,4, 6, 7… http://www.info-radiologie.ch/brain_mri_coronal_t2.php http://upload.wikimedia.org/wikipedia/commons/1/15/26638.medium-emphasizing-corpus-callosum.png

Cisterns Subarachnoid space- areas at brain base that are widened where CSF pools. Supracellar cistern- superior to sella- C of W Quadrigeminal cistern- posterior to quadrigeminal plate of midbrain Cisterna magna- lower posterior fossa (largest)

Cisterns http://pilgrimagetozion.files.wordpress.com/2009/07/cistern.jpg http://www.aans.org/bulletin/images/Vol17_2_08/Nonenhanced-axial-CT_large.jpg http://icanhascadherin.files.wordpress.com/2008/09/happy-face.jpg

What is wrong? http://www.scielo.br/img/revistas/anp/v66n3b/a32fig01.gif http://img.medscape.com/pi/emed/ckb/radiology/336139-336489-4514.jpg

Cerebral Lobes Cortex divided into 4 lobes: Frontal- anterior- reason, judgment, vol muscle Broca’s area for speech- LT frontal gyrus Parietal- middle of each hemisphere- post to central sulcus- temperature, touch, pain, taste Occipital- posterior- visual stimuli from thalamus Temporal- anterior to occipital-auditory/olfactory Primary auditory= Heschl’s- auditory info Secondary= Wernicke’s – comprehension/ speech

Cerebral lobes http://space.newscientist.com/data/images/archive/2222/22224201.jpg http://www.ispub.com/ispub/ijra/volume_4_number_1_46/neurological_damage_in_heat_stroke_in_a_child_ct_mri_and_spect_appearances/heat-fig2b.jpg

temporal cerebellum http://www.imaios.com/var/ezwebin_site/storage/images/media/images/e-anatomy/brain-mri/en/brain-anatomy-axial-atlas/4651-1-eng-GB/brain-anatomy-axial-atlas_imagelarge.jpg http://www.nature.com/bmt/journal/v39/n4/images/1705571f1.jpg

Case study= Heat Stroke The described imaging findings in heat stroke include early cerebral edema , loss of gray-white matter differentiation, patchy high signal intensity of the white matter of cerebral hemispheres and vascular boundary zone infarcts and in later stages, diffuse cerebellar atrophy -severe brain ischemia was the underlying cause for the neurological involvement in heat stroke in our patient. http://images.google.com/imgres?imgurl=http://www.ispub.com/ispub/ijra/volume_4_number_1_46/neurological_damage_in_heat_stroke_in_a_child_ct_mri_and_spect_appearances/heat-fig2b.jpg&imgrefurl=http://www.ispub.com/journal/the_internet_journal_of_radiology/volume_4_number_1_46/article_printable/neurological_damage_in_heat_stroke_in_a_child_ct_mri_and_spect_appearances.html&usg=__MOWFvBWDRgjINv-DxcrF_mmMfwM=&h=575&w=477&sz=41&hl=en&start=3&itbs=1&tbnid=EXEYVfzs4fUVPM:&tbnh=134&tbnw=111&prev=/images%3Fq%3Dcerebral%2Bcortex%2Bon%2BMRI%2Bor%2BCT%26gbv%3D2%26hl%3Den%26sa%3DG

Basal Ganglia Subcortical gray matter Caudate nucleus- lat to each lat ventricle Lentiform nucleus Claustrum Together they plan and program muscle action. http://www.brainexplorer.org/brain-images/brain_slice_small.jpg http://www.biomedcentral.com/content/figures/1471-2377-6-33-3-l.jpg

Diencephalon Thalamus Hypothalamus Epithalamus Lg oval grey masses, walls of lat vents, connects in mid 3rd vent by massa intermedia Hypothalamus Inferior to thalamus and posterior to optic chiasm, making floor of lat vent- Pituitary Gland (hypophysis)- connected by infaundibulum. Epithalamus Pineal gland- melatonin= day/night cycles (can Ca++)

Limbic System Interconnected fibers adjacent to temporal lobes. Emotional aspects of behavior Includes: hippocampus (short- long term memory converter), amygdala, olfactory tracts, fornix, cingulate gyrus.. Brain injury to hippocampus can cause….. Loss of memory…

Limbic system

Brainstem Major segments are: Midbrain Above the pons, smallest portion of brainstem Nerve bundles called cerebral peduncles and quadrigeminal plate. Surrounds the cerebral aquaduct- which connects the 3rd and 4th vents and contains CSF Pons Oval expansion of brainstem- “Bridge”- signals to spinal cord and cerebral cortex Medulla oblongata Extends to the spinal cord which exits the foramen magnum- heart rate, respiratory rate and blood pressure.

Brainstem

Cerebellum “Little brain” Posterior to brainstem and occupies posterior fossa Composed of two cerebellar hemispheres with a midline Vermis- on the inferior surface lie the cerebellar tonsils Occassionally they may herniate down the foramen magnum…..called what????

Cerebellum

Cerebellum Dandy Walker= refers to the enlargement of the posterior fossa secondary to cystic dilatation of the fourth ventricle as well as hypoplasia of the cerebellum and vermis.

What is wrong? Lt cerebellar abscess Congenital absence of one cerebellar hemisphere

Types of brain lesions… PNET-Primitive Neuroectodermal tumors PNET can occur anywhere in the brain of a child, although the most common place is in the back of the brain near the cerebellum. When they occur here, they are called medulloblastomas. The symptoms depend on their location in the brain, but typically the child experiences increased intracranial pressure. These tumors are fast growing and often malignant, with occasional spreading throughout the brain or spinal cord.

Cerebral Vasculature Arteries in the brain are thin and weak. high risk for aneurysms and strokes. No valves in the veins-blood can flow in either direction= route for blood-bourne pathogens. Dural sinus drains down to the IJ’s- through the superior and inferior sagittal sinus Unique capillaries create the Blood Brain Barrier

Arterial- Blood to Brain Paired internal carotid and vertebral arteries. Internal carotid becomes- Carotid Siphon Anterior cerebral-ACA Middle cerebral-MCA Circle of Willis= Located in Suprasellar cistern- cerebral arterial circle- anastomosis of 4 major arteries…. What are they? Two vertebral and Two carotids…. becoming the anterior/posterior cerebral, anterior/posterior communicating and internal carotids

Brain Blood Supply

Circle of Willis

Venous Blood Parietal Veins Superior Sagital Sinus Confluence of Sinus Transverse Sinus Sigmoid Sinus Internal Jugular Veins

Which is it? MCA stroke- frontal/temporal lobe with Wedge shaped area of decreased density and Slight midline shift/ mass effect Aneurysm AVM

Cranial Nerves 12 cranial All but 1st and 2nd arise from the brainstem Each nerve corresponds to a function in the body Olfactory- smell- superior nasal septum Optic-sight-posterior aspect of eye Facial-lower pons- control facial muscles Vagus-”wandering”- down to splenic flexure of abd and arise from medulla oblongata- enervates many abdominal organs

Cranial Nerves